Wu Shuzhen, Pan Junhan, Song Mengchen, Zhao Yan-Ci, Chen Wuyue, Huang Huizhen, Zhu Yanyan, Chen Feng
Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou 310003, China (S.W., J.P., M.S., Y.C.Z., W.C., H.H., Y.Z., F.C.).
Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79 Qingchun Road, Hangzhou 310003, China (S.W., J.P., M.S., Y.C.Z., W.C., H.H., Y.Z., F.C.); Department of Radiology, Shulan (Hang Zhou) Hospital, No. 848 Dongxin Road, Hangzhou 310003, China (M.S.).
Acad Radiol. 2025 Mar 30. doi: 10.1016/j.acra.2025.03.008.
MRI proton density fat fraction (MRI-PDFF), controlled attenuation parameters (CAP), and attenuation coefficients (AC) are capable of steatosis characterization and may be useful as noninvasive alternatives for diagnosing hepatic steatosis.
This meta-analysis aimed to evaluate the performance of MRI-PDFF, CAP, and AC in grading hepatic steatosis, using histology as the reference standard.
We conducted a comprehensive search of the PubMed, Cochrane Library, Embase, and Web of Science databases until June 2024. The quality of eligible studies was assessed. Pooled sensitivity, specificity, and area under receiver operating characteristic (AUC) curves were calculated using a bivariate random-effects model. Meta-regression analysis, subgroup analysis, and Deeks' test were performed to explore heterogeneity and assess publication bias.
This meta-analysis included 38 studies with 5056 patients with metabolic dysfunction-associated steatotic liver disease. The AUC values for grading steatosis ≥S1, ≥S2, and ≥S3 were 0.99, 0.89, and 0.90 for MRI-PDFF, 0.95, 0.84, and 0.77 for CAP, and 0.97, 0.90, and 0.89 for AC, respectively. CAP demonstrated lower accuracy for detecting steatosis grades ≥S2 and ≥S3 compared to MRI-PDFF (0.89 vs. 0.84, p<0.001; 0.90 vs. 0.77, p<0.001) and AC (0.90 vs. 0.84, p<0.001; 0.89 vs. 0.77, p<0.001). Subgroup analyses revealed that MRI-PDFF and CAP exhibited superior diagnostic performance in diagnosing ≥S2 and ≥S3 steatosis among individuals in Asia, with a body mass index ≤30 kg/m, and age <51 years.
A direct comparison with CAP showed greater accuracy for MRI-PDFF and AC in diagnosing moderate and severe steatosis, and similar diagnostic performance for MRI-PDFF and AC. For patients with steatosis, AC should be incorporated into routine ultrasound screening.
磁共振成像质子密度脂肪分数（MRI-PDFF）、受控衰减参数（CAP）和衰减系数（AC）能够对肝脂肪变性进行特征化分析，可用作诊断肝脂肪变性的非侵入性替代方法。
本荟萃分析旨在以组织学为参考标准，评估MRI-PDFF、CAP和AC在肝脂肪变性分级中的性能。
我们对截至2024年6月的PubMed、Cochrane图书馆、Embase和Web of Science数据库进行了全面检索。评估符合条件的研究的质量。使用双变量随机效应模型计算合并敏感性、特异性和受试者工作特征曲线下面积（AUC）。进行荟萃回归分析、亚组分析和Deeks检验以探讨异质性并评估发表偏倚。
本荟萃分析纳入了38项研究，共5056例代谢功能障碍相关脂肪性肝病患者。对于脂肪变性分级≥S1、≥S2和≥S3，MRI-PDFF的AUC值分别为0.99、0.89和0.90，CAP的AUC值分别为0.95、0.84和0.77，AC的AUC值分别为0.97、0.90和0.89。与MRI-PDFF（0.89对0.84，p<0.001；0.90对0.77，p<0.001）和AC（0.90对0.84，p<0.001；0.89对0.77，p<0.001）相比，CAP在检测脂肪变性分级≥S2和≥S3时准确性较低。亚组分析显示，在亚洲、体重指数≤30kg/m²且年龄<51岁的个体中，MRI-PDFF和CAP在诊断≥S2和≥S3级脂肪变性方面表现出更好的诊断性能。
与CAP的直接比较表明，MRI-PDFF和AC在诊断中度和重度脂肪变性方面具有更高的准确性，且MRI-PDFF和AC的诊断性能相似。对于脂肪变性患者，AC应纳入常规超声筛查。
